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Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Watershed Permitting Program
Sanitary Sewer Overflow (SSO)/Bypass
Notification Form
FOR DEP USE ONLY
Tax Identification Number
A. General Information
1. Facility Information
MA0101818
a. Reporting Facility Permit Number
Northampton Department of Public Works
f \ \a/a3 A5
b. Name of Collection System/Treatment Works
2. Authorized Representative filing this notification form:
Edward Huntley
a. First Name b. Last Name
Director of Public Works nhuntley @nohodpw.org
413-587-1570
c. Telephone(10)
d. Title of Authoried Representative e. E-mail Address of Authorized Representative
3. Event Report Information
a. Are you reporting: ® 1. Unanticipated SSO or Bypass ❑2.Anticipated SSO or Bypass
B. Phone Notifications Made, if any:
Kurt
a. first name
1.
MassDEP person contacted.
Date/Time MassDEP contacted by phone:
2. EPA person contacted: George
a. first name
Date/Time EPA contacted by phone:
3. Others notified(select all that apply):
❑c. Harbormaster ❑ d.Downstream WS
❑g.Other:
12/20/2013
c. Date (mm/dd/yyyy)
Harding
b. last name
Boisjolie
b. last name
Time:
02/20/2013 Time:
c. Date(mnyddlyyyy)
03:00
d.bh:mm
03:10
d. hh:mm
❑e.am
f.Pm
❑e.am
Elf am
❑ a. Conservation Commission ®b. Board of Health
❑ e.Watershed Association ❑f. Shellfish Warden
h.Specify
C. General Information About SSO/Unanticipated Bypass
1.
2.
3.
When did the event occur?
Location of event:
12/20/2013
a Date(mm/dd/yyyy)
160 Grove Street
Time:
a.Number and Street(or closest address)
Estimated volume of overflow discharge at the time of this report:
1, 0 65 gallons
Estimated Volume:
Method of estimating volume:
4. Where did the overflow discharge to? (e.g.,
surface water, ground)
11:45 ®c.am
b. hti:mm ❑O.pm
42-18-28 72-38-59
b.latitude c.longitude
Approximately 3 inches of sewage on cellar floor
Cellar of 160 Grove Street
160 Grove Street 20131220_SSO Notifx:ation.docx•rev.07/2010 Wastewater Overflow/Bypass or Sewage Backup Notification•Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Watershed Permitting Program
Sanitary Sewer Overflow (SSO)/Bypass
Notification Form
FOR DEP USE ONLY
Tax Identification Number
C. General Information About SSO/Unanticipated Bypass (cunt.)
5. Identify causes of/reasons for the event. (select all that apply)
❑a. rain
❑d. insufficient capacity
❑t. pump/lift station failure
❑ h.Other:
❑ b. snowmelt ❑c. high groundwater
® e. sewer system blockage or collapse
❑g. treatment facility equipment failure
Paper, grease and other unidentified debris
Specify
6. Have corrective actions been completed? Z a. Yes ❑ b. No ❑ c.No Action Required
7. Corrective measures taken(select all that apply, or use Section E to attach additional comments):
®a. repaired sewer/cleared ❑b repaired pump/lift ❑c. repaired service
blockage station connection
❑d. drained or pumped ❑r backflow prevention
sewage out of building ❑e. disinfection treatment device installed
❑g. Other: h. Specify
D. General Information About Anticipated Bypass
1. When will the bypass occur? a. Date(mmmdryyyy) Time:
2. Where will the bypass Occur? a. Number and Street(or closest address)
3. Estimated volume of overflow discharge at the time of this report:
a. Estimated volume:
b. Method of estimating volume:
4. Identify causes of/reasons for the event: (select all that apply)
❑a. rain
❑d. insufficient
capacity
❑ r pump/lift
station failure
❑g.Other:
❑b. snowmelt
❑ e. sewer system blockage or collapse
❑
g treatment facility equipment failure
b. hh:mm
b.latitude
❑ c.am
❑d.pm
c.longitude
❑ c. high groundwater
Specify
5. Will an SSO occur during the bypass? ❑a. Yes
a.1. Where will SSO discharge to?
A 5-day follow-up report is required for the SSO.
❑ b.No
160 Grove Street 20131220_SS0 Notification docx•rev.07/2010 Wastewater Overflow/Bypass or Sewage Backup Notification•Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Watershed Permitting Program
Sanitary Sewer Overflow (SSO)/Bypass
Notification Form
FOR DEP USE ONLY
Tax Identification Number
D. General Information About Anticipated Bypass (cont.)
Please be advised that if the anticipated bypass detailed above results in an unanticipated
bypass/SSO, MassDEP must be notified within 24 hours and a new form completed.
Please provide comments in Section E detailing the preventive measures to be taken during the event.
E. Comments/Attachments/Follow-up
I wish to provide(select all that apply):
Z 1.Attachment D 2. Additional comments below: ❑ 3.No additional comments or attachments
2a. Additional comments and planned actions.
F. Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or persons
who manage the system, or those persons directly responsible for gathering the information,the
information submitted is,to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of
fine and imprisonment for knowing violations.
� 5 / roM
1.Signature of Authorized Represen ve 2.G to Sgned
Please keep a copy of this report for your records.When submitting additional information, include
the MassDEP Incident Number from this report.
MassDEP Regional Office and EPA Telephone and Fax Numbers:
Northeast Region
Southeast Region
Central Region
Western Region
EPA Contact
DEP 24-hour
emergency
Phone: 978-694-3215
Phone: 508-946-2750
Phone: 508-792-7650
Phone: 413-784-1100
Phone: 617-918-1766
Phone. 888-304-1133
Fax: 978-694-3499
Fax: 508-947-6557
Fax: 508-792-7621
Fax: 413-784-1149
160 Grove Street 20131220_SSO Notification docx•rev.07/2010 Wastewater Overflow/Bypass or Sewage Backup Notification•Page 3 of 3
SANITARY SEWER OVERFLOW—160 Grove Street,Chronology
Friday December 20,2013
11:45 AM Northampton DPW was notified of a sanitary sewer overflow at 160 Grove Street.
DPW staff observed approximately 3 inches of sewage covering three quarters of the cellar floor
at 160 Grove Street.
12:00 PM(approximately) DPW staff opened the sewer manhole in front of 160 Grove Street
and found sewage filling the manhole to just below the rim. Paper and grease were observed
floating in the structure. DPW staffjet-rodded the sewer line and released the blockage. The
sewer line flowed full for approximately half an hour after clearing the blockage.
12:45 PM DPW staff observed the sewer main flowing freely.
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